Enjoying EarthSky? Subscribe.

Gabriela Salvador on Pro Mujer in Latin America

Gabriela Salvador said, “It is a one-stop shop. Women come to us for loans and we take the opportunity to reach out to them and give them health services and education.”

Image Credit: Alicia Fox/Pro Mujer

Whole Planet Foundation – part of Whole Foods Market – works with Pro Mujer in five countries. Whole Planet’s mission is to alleviate poverty through microcredit in countries where Whole Foods Market sources products. They work in partnership with organizations that offer microcredit loans for entrepreneurship – to enable impoverished women in developing countries with the chance to create or expand a home-based business to lift herself and her family of poverty. In 2010, Pro Mujer started an innovative pilot program in Nicaragua that combines small loans with essential primary health services like screenings, trainings and access to doctors. Dr. Salvador spoke more about ProMujer and the women they serve with EarthSky’s Jorge Salazar.

What is Pro Mujer?

Pro Mujer is a non-profit women’s development and microfinance organization dedicated to alleviating poverty and empowering women in Latin America. Pro Mujer provides women with easy and convenient access to essential training and services that are typically out of reach because of their socioeconomic status.

The services include microfinance – which are small loans – savings, insurance, business and empowerment training. And we offer high-quality, low-cost primary healthcare services such as preventative health education, screenings and treatment for particular diseases.

What’s happening with primary care health services in Latin America, and how is Pro Mujer involved?

Let’s first take a look at women that Pro Mujer works with. We reach over 200,000 clients in five countries in Latin America — Bolivia, Peru, Nicaragua, Mexico and Argentina.

These women are very low-income women – head of households or single mothers – running small businesses. For example, they might sell fruits or food on the streets. They earn between two and 10 dollars per day. For them, a day without work is a day without income. And there is no safety net. So, for example, three dollars spent on transportation to the hospital are really three dollars not spent on food or school supplies for their children.

Pro Mujer offers health care services, in addition to small loans for women in business. Via ProMujer on Picasa

They depend on their daily income to survive. And they don’t use health services unless it’s an urgent matter. So, for them, the utilization of health services – even if the services are free at point of service – is complicated because it involves the cost of transportation, not working, neglecting your children.

That makes these women very difficult to reach.

Public health in Latin America has improved significantly in the last decades, particularly in areas such as maternal and child health. In many regions, there are incentives for low-income people to utilize these services. They are paid to utilize them. On the other hand, there are still no solutions to address the increasingly growing problem of chronic diseases such as diabetes and high blood pressure.

Why is this? Because the region in general is witnessing a massive migration of people from rural areas to the city. This trend has resulted in higher percentages of the population leading a more sedentary lifestyle. They may consume more fast food and have limited or no physical activities. The rates of obesity are shockingly high. As a result, there is an alarming increase in diseases such as diabetes or hypertension.

Adding to the problem is that these chronic diseases are silent. In the early stages, there are no obvious symptoms. The disease may go undetected until the person develops complications.

These complications can be catastrophic: kidney failure, heart failure, things that usually cannot be solved, but can eventually be controlled at a big cost. And so they are catastrophic for those suffering from the disease and their families.

It also comes at a great cost for the countries of these women. Money that goes to healthcare does not go to education or creating jobs. So, to fight these conditions, it is very important to focus on prevention and early detection of diseases through screening – and also to raise awareness of these problems to induce changes in behavior.

Marta Martinez, a Pro Mujer client for seven years, makes fine pottery in a rural area outside of León, Nicaragua. Marta’s business is the economic foundation for her family, enabling her three children to attend school. Via Pro Mujer on Picasa. Courtesy Whole Planet Foundation.

That said, for the public health sector reaching out to the community in an effective way is usually very expensive. Institutions like Pro Mujer – because of the nature of its business, where women come looking for a credit or a loan – have a captive market that happens to be that segment of the population that is at very high risk to develop these diseases.

Tell us about some of the things Pro Mujer is doing to address these problems throughout these countries in Latin America that you described.

Pro Mujer, since its beginnings in Bolivia more than 20 years ago, was conceived as an institution focused on empowering women by providing education, access to health services and microfinance services to support their business

Microfinance was the hook to get to these women and be able to provide health services and training. So we have experience providing these basic health services to our clients, and we are constantly trying to innovate and expand these services with the support of organizations that share our vision, such as Whole Planet Foundation.

In Nicaragua, we are conducting a pilot. It’s really a health initiative that is a concerted effort with Link Foundation and global partnerships and PATH to adjust and improve our health models. We want to comply with four key criteria. First, respond to what the women need and what they are demanding. Second, choose those health interventions that are high impact. Third, run the services in a sustainable way. Fourth, make the operations viable.

The health initiative in Nicaragua is focused on training, access to a family doctor, and early detection through screening of conditions such as hypertension, diabetes, obesity, breast and cervical cancer. And also we do blood tests and urine tests. These conditions were selected due to their prevalence in the population we work with and also because these are conditions that are not successfully been attended to in the public sector.

Our goal is never to compete with the public sector, but really compliment them and try to help by filling niches that are gaps in the system really.

This new health pilot program recently completed its first year in Nicaragua. How’s it going so far?

The health model is going very well. It is an initiative full of success stories and also lessons learned. If we look for a financial sustainability, we need clients to be willing to pay for the cost of the service. Pro Mujer has learned that preventive services can be sold after intensive awareness campaigns.

Andaluz Ascencia sows uniforms for children in the schools of Condega, Nicaragua. Andaluz would like to grow her business by buying a larger sewing machine and a fabric cutter. Via Pro Mujer on Picasa. Courtesy Whole Planet Foundation.

That said, even when most clients are satisfied with the information and the health service delivered, preventive medicine only has a short-term commercial appeal. People are willing to pay for this once or twice, and then the novelty wears off. It is vital to constantly improve the value of the package and the service offered and surpass client’s expectations. That is why we combine preventive services and early diagnosis with other services for which there is high demand – such as dental services.

Payment mechanisms are also key. We are moving away from a la carte types of payment system, which is a fee for services, to a system of a monthly flat fee of around two dollars. Changing the payment system to a monthly modest fee allows you to use the services basically free at point of care. Whenever you need them, you don’t have to pay for them. It’s already paid for. Clients appreciate and like that.

Very low-income women care very much about their health. It is just that there are so many competing priorities – their small business, their families, children, school. Devoting time for themselves and their own well-being is a luxury. If they can have an annual check-up while paying their loans at the one-stop shop, they welcome the opportunity.

What’s the next step?

Our surveys and market research have shown great demand for medicine specialty consultations and dental care. Pro Mujer is partnering with other NGOs to provide dental and eye care together with the preventative services, early diagnosis and access to primary care physicians. The idea is to expand our range of services, making the health offerings more attractive to clients, but always really focusing on high impact interventions.

Johanna Gutierrez runs a small neighborhood store, or pulperia, in the town of Esteli, Nicaragua. A Pro Mujer Client for two years, Johanna also wants to open a clothing store. Via Pro Mujer on Picasa. Courtesy Whole Planet Foundation.

We’re also implementing the monthly installments so that paying is not a burden for our clients.

We are incorporating also nutritional counseling to help with the obesity and overweight problems.

And we also want to provide some small health loans to help women complete treatment should they seek, for example, dental treatment or need glasses.

These podcasts were made possible by Whole Planet Foundation. Founded in 2005, Whole Planet Foundation is a Whole Foods Market foundation promoting poverty alleviation worldwide where the company sources products. The Foundation’s mission is to empower the very poor living in developing-world communities a chance to create or expand a home-based business and lift themselves and their families out of poverty through microcredit. As of June 2011, the Foundation is authorized for $22 million and has disbursed $16 million through microfinance institution partners in 46 countries in Africa, Asia, Latin America and the U.S. This support is benefiting nearly one million people with a chance for a better life.

Jorge Salazar has conducted thousands of in-depth interviews with scientists in the process of creating science content for EarthSky. He also helps host the 90-second EarthSky podcasts. Jorge has a bachelor's degree in physics from the University of Texas at Austin. He knows a lot about a lot of different things. For EarthSky, he has explored subjects as diverse as nanotechnology, ecosystem-based management, climate change, global health, international environmental treaties, astrophysics and cosmology, and environmental security. His penetrating research style, poetic writing, and ability to track down and speak with Nobel prize-winning laureates, all make him a huge asset to EarthSky.